There are multiple sites in which IO access can be obtained
Proximal humerus – insert about 1 cm above the surgical neck (which can be found by sliding a finger up the anterior humeral shaft until the greater tubercle is felt)
- Of note, this is the preferred insertion site during resuscitation, especially those involving abdominal trauma, as medications and fluids enter the circulation faster as they reach the central circulation via the SVC and bypass the pelvic and abdominal vessels.
Proximal tibia – insert 2 finger breadths below the patella and 1-2 cm medial to the tibial tuberosity in adults
Distal tibia – insert 3 cm proximal to the most prominent aspect of the medial malleolus
Femur, iliac crest, sternum – not routinely used and may require a special device
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